Gender affirming surgery (GAS), also known as gender confirmation surgery or gender reassignment surgery, is a medical solution for many individuals seeking to align their physical bodies with their gender identity. This transformative surgery is designed to improve the quality of life for those experiencing gender dysphoria. However, an essential question that arises is whether such surgeries are covered or funded by the Canadian healthcare system. In this article, we’ll explore the nuances of gender affirming surgery and the varying coverage available in Ontario.

Types of Gender Affirming Surgery

Gender affirming surgery encompasses a range of procedures aimed at modifying the body to reflect an individual’s gender identity. Typically categorized under two main streams, these surgeries include male-to-female (MTF) and female-to-male (FTM) procedures.

MTF Gender Affirming Procedures 

MTF surgeries often include:

• Breast augmentation, which creates, shapes, and/or enlarges breasts by inserting implants. 
• Orchiectomy, which is the removal of the testicals. 
• Vaginoplasty, which involves the construction of a vagina using soft tissue from the patient’s pelvic area. 

FTM Gender Affirming Procedures

FTM surgeries can include:

• Chest masculinization, otherwise known as top surgery, involves the removal of breast tissue to create a traditionally masculine flat chest. 
• Hysterectomy, which is the removal of the uterus.
• Phalloplasty, which constructs male genitalia from soft tissue. 
• Metoidioplasty, another form of bottom surgery. Unlike with a phalloplasty, a metoidioplasty uses the clitoris to create the male genitalia. 

Healthcare Coverage for Gender Affirming Surgery in Ontario

OHIP covers gender affirming surgeries that fall under the umbrella of medically necessary treatments. In order for your procedure to be deemed medically necessary, a doctor must confirm you suffer with continuous gender dysphoria. Residents of Ontario can obtain financial assistance through OHIP to cover various gender confirmation surgeries. These individuals must meet specific criteria to access these surgical procedures without incurring out-of-pocket expenses. 

Eligibility Criteria for Coverage

To qualify for publicly funded gender affirming surgeries, patients typically need to meet certain eligibility criteria established by their provincial health plans. In Ontario, OHIP covers genital and chest-related gender affirmation surgery. You must meet the following requirements to qualify for either surgery:

• A healthcare provider has assessed you and recommended the surgery. 
• A referral for the surgery has been submitted to the Ministry of Health and Long-Term Care by a healthcare provider. 
• The surgery was approved by the Ministry of Health and Long-Term Care
• Two assessments from different healthcare providers recommend genital surgery (genital surgery only)
• Two assessments from different healthcare providers diagnose the patient with persistent gender dysphoria (genital surgery only)
• Two assessments from different healthcare providers confirm the patient has completed 12 straight months of hormone therapy.  (genital surgery only)
• Two assessments from different healthcare providers confirm the patient has lived 12 consecutive months as the gender they identify with (genital surgery only). 

Confirm with your healthcare provider what of these requirements best apply to you and your situation, they will be able to provide personalized guidance and solutions. 

Waiting Times for Gender Affirming Surgery

Waiting times can be a significant barrier to timely care. Many face lengthy delays from the time they secure approval for gender affirming surgery until the procedure itself can be scheduled. Depending on the procedure, gender affirming surgeries can have a wait time ranging from half a year to over a year. Accessibility will vary depending on the individual surgeons’ waitlist and hospital access. Be mindful when deciding who to work with, as certain surgeons will have longer waiting times than others. 

Costs Associated with Gender Affirming Surgery

Many patients choose to access gender affirming surgeries through public healthcare funding. Even if funded by OHIP, there are associated costs that may incur, such as expenses related to preoperative consultations, travel, and post-operative care. The coverage of these expenses can vary, we recommend that those interested verify what level of coverage they have by asking their healthcare provider. The consultations needed to receive a referral and meet OHIP’s requirements can also come with out-of-pocket costs. 

To pay for a gender affirming surgery out of pocket, it will cost anywhere between $4000 to $10,000 CAD. The cost will depend on the complexity of the procedure. For example, reconstruction will typically run more expensive than other surgical procedures. 

Understanding the types of surgeries available, navigating the eligibility criteria, and being aware of potential costs are essential steps for those seeking gender affirmation surgery. Consulting with healthcare providers, advocacy groups, and community resources can provide essential guidance, empowering them to access the support they need on their journey toward personal affirmation.

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